With the new and different atrial fibrillation drugs on the market, is it time for you to consider switching your atrial fibrillation treatment? Here's what you need to know.

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If you have atrial fibrillation, you may be taking some type of medicine. In fact, more often than not, your atrial fibrillation treatment may require a few different types of drugs.

"Medical therapy for atrial fibrillation has three components — rate control, designed to slow a rapid heart rate; rhythm control, designed to eliminate or lessen atrial fibrillation events; and stroke prevention for those at risk, with blood thinners or anticoagulants," says Jonathan Steinberg, MD, director of the Arrhythmia Institute at the Valley Health System in New York City and Ridgewood, N.J.

Usually, people with atrial fibrillation are on some combination of these atrial fibrillation medicines worked out carefully by their doctor. "Patients with minimal symptoms may need only rate control and stroke prevention," says Anne Dougherty, MD, a cardiac electrophysiologist and professor of internal medicine at the University of Texas Health Science Center at Houston. "Those with more significant symptoms may warrant rhythm control measures."

Advances in Atrial Fibrillation Medicine

Atrial fibrillation drugs in the category of stroke prevention have been gaining attention of late. The standard options have been aspirin for those at a low stroke risk and warfarin, brand names Coumadin and Jantoven, for those at a higher risk. But two new drugs that have come on the market are changing how doctors approach atrial fibrillation treatment.

"Recently, the FDA has approved two novel medications, Pradaxa (dabigatran) and Xarelto (rivaroxaban), for stroke prevention in atrial fibrillation not associated with significant heart valve disease," says Rajesh Kabra, MD, an assistant professor of medicine and director of Electrophysiology Services at the University of Tennessee Health Sciences Center in Memphis. "These are alternatives to warfarin, the age-old traditional blood thinner that is inconvenient to use and requires constant blood monitoring. The new drugs do not require any blood monitoring and proved superior to warfarin in the prevention of stroke."

What to Consider in Switching Afib Medications

Considering the promising findings on these new atrial fibrillation drugs, it's understandable that some people would like to switch. Though this can be done, experts say it's not as simple as dropping one drug for another. It can be a delicate process that must be watched carefully. "The therapeutic strategy should be under constant review by the patient's caregiver," says Dr. Steinberg. "If atrial fibrillation is progressive, or symptoms bothersome, a change in strategy is appropriate to consider, always weighing the advantages and disadvantages of the spectrum of options." Another circumstance that might warrant change would be if your current medications are causing adverse effects, he says, noting that all of this should take place under the direct supervision of your doctor.

In particular, problems tolerating warfarin may lead you and your doctor to consider switching atrial fibrillation medication. "Any patient who is not tolerating warfarin, has problems with blood monitoring, or has had a stroke even on warfarin might consider switching to the new medication," says Dr. Kabra, who also cautions that "the switch needs to be discussed with the physician and carried on based on the physician's recommendations."

Finally, know that although promising, like all medications, these new atrial fibrillation drugs are not without some downsides. "Although these are much more convenient to use, they are also much more expensive," says Dr. Dougherty. In addition, "there is some controversy about their use, since there is no direct antidote to their effect," he said.

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